NPIMap

Organization Active NPI

Kanawha Valley Radiologists Incorporated

  • Diagnostic Radiology Physician
  • South Charleston, WV
National Provider Identifier
1609975630
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
KANAWHA VALLEY RADIOLOGISTS INCORPORATED
Practice address
4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone
(304) 766-3600
Fax
(304) 343-4626
NPI assigned
Sep 22, 2006
Last updated
Apr 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel A Rodgers, MDNPI 1255508644
Title
Authorized Official
Phone
(304) 343-4625

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X WV Primary

Addresses

Primary practice location

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311

Mailing address

PO Box 840
Lima, OH 45802-0840
Phone (877) 574-7116

Other practice location 1

333 Laidley St
Charleston, WV 25301-1614
Phone (304) 347-6500

Other practice location 2

4800 MacCorkle Ave SW
South Charleston, WV 25309-1332
Phone (304) 767-7730

Other practice location 3

2520 Valley Dr
Point Pleasant, WV 25550-2031
Phone (304) 675-4340

Other identifiers 6

IdentifierTypeStateIssuer
0008099000MedicaidWV
020021700OtherWVFEDERAL BLACK LUNG
0216288OtherOHOHIO MEDICAID
5643OtherWVCARELINK
001709440OtherWVMT STATE BLUE CROSS GRP #
0060705MedicaidOH

National Provider Directory

National Provider Directory

Locations

405 Capitol St
Ste 500
Charleston, WV 25301
Phone (304) 343-4625

1095 Fledderjohn Rd
Charleston, WV 25314
Phone (304) 345-4674

1097 Fledderjohn Rd
Charleston, WV 25314
Phone (304) 345-3627

4800 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 306-3049

4501 Maccorkle Ave SW
Ste 301
South Charleston, WV 25309
Phone (304) 768-0501

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1609975630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020840",
            "telephone_number": "877-574-7116",
            "fax_number": "419-223-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-766-3600",
            "fax_number": "304-343-4626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Laidley St",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011614",
            "country_code": "US",
            "telephone_number": "304-347-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4800 MacCorkle Ave SW",
            "address_purpose": "LOCATION",
            "city": "South Charleston",
            "state": "WV",
            "postal_code": "253091332",
            "country_code": "US",
            "telephone_number": "304-767-7730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2520 Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Point Pleasant",
            "state": "WV",
            "postal_code": "255502031",
            "country_code": "US",
            "telephone_number": "304-675-4340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KANAWHA VALLEY RADIOLOGISTS INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "304-343-4625",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008099000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "020021700",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO MEDICAID",
            "identifier": "0216288",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARELINK",
            "identifier": "5643",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT STATE BLUE CROSS GRP #",
            "identifier": "001709440",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060705",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.